The US Centers for Disease Control and Prevention (CDC), the Lancet Commission on Hypertension Group, Resolve to Save Lives (RTSL), and the World Hypertension League (WHL) share a collective goal of expanding the evidence base on hypertension, sodium, and trans fatty acid reduction strategies as a critical pathway to preventing and managing cardiovascular diseases. An important strategy for achieving this goal is to increase opportunities for investigators in low‐ and middle‐income countries to contribute their studies in these areas to the scientific literature.
CDC collaborates with partners to enhance health and economic security and reduce premature disability and death by facilitating prevention, detection, and response to global public health threats. CDC tackles the global non‐communicable disease burden by working with countries to improve public health systems, strengthen workforce, and generate scientific evidence.
In 2019, CDC began a mentorship collaboration with the Lancet Commission on Hypertension Group, RTSL, and WHL. CDC and RTSL invited 35 public health trainees and practitioners working on RTSL‐supported hypertension, sodium, and artificial trans‐fat initiatives in low‐ and middle‐income countries to propose manuscripts that could enhance the evidence base and inform future work. Potential authors were paired with mentors from the Lancet Commission on Hypertension Group to define a clear study aim, describe methods, and present and discuss the results. Mentors helped authors strengthen their scientific communication and dissemination skills and share project results with the larger scientific community, thus increasing the global impact of their work.
RTSL aims to reduce disability and deaths from cardiovascular disease worldwide through its Cardiovascular Health Initiative, which focuses on three main interventions: population salt reduction, trans fatty acid elimination, and hypertension control. RTSL is based at non‐governmental global health organization Vital Strategies, and partners closely with CDC Foundation, the World Health Organization (WHO), Johns Hopkins University and, the Global Health Advocacy Incubator.
RTSL collaborated with WHO to develop and promote the REPLACE Action Package, a set of tools to eliminate trans fatty acids from national food supplies, with the goal of global elimination by 2023. Since then, RTSL and its partners have supported trans fatty acid elimination efforts in 24 countries. RTSL and its partners also support the implementation and scale‐up of national hypertension programs including efficient opportunistic screening in health care facilities and community‐based chronic care convenient to patients. 1 While RTSL primarily funds activities in nine focus countries, the Cardiovascular Health Initiative aims to foster a global learning community around cardiovascular health promotion. The dissemination of best practices and lessons learned across all three interventions by public health trainees and practitioners in the countries participating in the initiative, whether from RTSL‐funded projects or other groups, is a crucial part of this effort.
The Lancet Commission on Hypertension Group collaborates with partners to identify and support actions to improve blood pressure globally. In September 2016, at the International Society of Hypertension conference in Seoul, the Lancet Commission on Hypertension presented 10 mutually additive and synergistic key actions which, if implemented effectively and broadly, would make substantial contributions to the prevention and management of blood pressure globally. 2 Since then, the Lancet Commission on Hypertension Group has collaborated with partners to implement these key actions, with a special focus on low‐ and middle‐income countries, where the burden of hypertension and cardiovascular disease are increasing.
To increase hypertension awareness and improve access to measurement of blood pressure, the Lancet Commission on Hypertension Group has been active in May Measurement Month. 3 , 4
To improve quality of blood pressure measurements, the Lancet Commission on Hypertension Group is active in the “AIM‐BP Collaborative” and the “VALID BP project” promoting the use of rigorously validated blood pressure monitors, endorsed protocols, and certificate courses for measuring blood pressure. 5 , 6 , 7
To facilitate empowerment and workforce expansion, the Lancet Commission on Hypertension Group collaborates with research groups testing different methods to empower community health workers to improve population lifestyle interventions. 8 The Lancet Commission also supports the development and testing of a mobile app to manage diabetes and hypertension (ManDiT project) in rural India.
Through the current initiative, the Lancet Commission has mentored investigators working in low‐and middle‐income countries to facilitate greater representation in the literature and expand the evidence base on hypertension awareness, use of standardized treatment, and improved patient follow‐up, which are all championed by the Lancet Commission on Hypertension Group.
WHL is dedicated to the prevention and control of hypertension at the population level and is delighted to use WHL's official journal, the Journal of Clinical Hypertension, to publish a special issue showcasing articles written by investigators in low‐ and middle‐income countries. WHL was especially enthusiastic about this collaboration as it is designed to build and enhance the scientific experiences of public health trainees and practitioners through close mentoring by international leaders. WHL is comprised of multiple national, regional, and international specialty organizations in the fields of hypertension and the prevention of cardiovascular disease, stroke, and kidney disease. WHL is committed to enhance the clinical care of hypertension and related conditions across all parts of the world; support public advocacy for confronting adverse dietary practices such as use of excess salt and artificial trans‐fats; educate workers at all levels of health care systems; and—as exemplified by this special publication—help build careers of trainees and practitioners who WHL hopes will continue to contribute to the missions of WHL and its partner organizations.
The current special section in the Journal of Clinical Hypertension includes six papers led by investigators from different countries or regions participating in the mentorship collaboration.
Martinez et al describe trends and disparities of cardiovascular disease burden for 37 countries of the WHO Region of the Americas from 1990 to 2017 using Global Burden of Disease data. The findings are important from a policy perspective as the slowdown in the reduction of premature mortality from cardiovascular disease may prevent attaining the UN Sustainable Development Goal of a one‐third reduction in premature mortality from non‐communicable diseases by 2030.
Yueayai et al present the results of a pilot study on a method to enhance hypertension diagnosis in a hospital in Thailand. Their intervention of electronic pop‐up messages and follow‐up protocol interventions significantly increased hypertension diagnosis and follow‐up among hypertensive patients.
Krishna et al report on the perspective of private health care providers in the state of Madhya Pradesh of India on adopting key strategies of the India Hypertension Control Initiative using a qualitative method. The study importantly suggests that private sector engagement in The Indian Hypertension Management Initiative is feasible.
Demin et al explore current trans fatty acid elimination policies in member states of the Eurasian Economic Union. The results showed that these countries are not achieving the WHO guideline of <2% of total fat content in all food products and suggest to adopt better regional policy measures.
Tarar et al describe the complexities of trans‐fat prevalence and control in the food supply in Pakistan and suggest development of a comprehensive national strategy for trans fatty acid elimination.
Chavasit et al describe the consumption and strategies for the reduction of trans fatty acid in Thailand based on a strengths, weakness, opportunities, and threat analysis. The article suggests a partnership between different stakeholders to reduce trans fatty acids in Thailand.
The above articles expand the evidence base on preventing and managing cardiovascular diseases and contribute to building the scientific dissemination capacity of investigators in low‐ and middle‐income countries.
All supporting partners are pleased to highlight this important work. A future special section will spotlight additional studies from investigators participating in the mentorship collaboration.
CONFLICT OF INTEREST
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Olsen MH, Neupane D, Cobb LK, et al. Global cardiovascular disease prevention and management: A collaboration of key organizations, groups, and investigators in low‐ and middle‐income countries. J Clin Hypertens. 2020;22:1293–1295. 10.1111/jch.13939
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